Does lung diffusion impairment affect exercise capacity in patients with heart failure?

Objective: To determine whether there is a relation between impairment of lung diffusion and reduced exercise capacity in chronic heart failure. Design: 40 patients with heart failure in stable clinical condition and 40 controls participated in the study. All subjects underwent standard pulmonary function tests plus measurements of resting lung diffusion (carbon monoxide transfer, Tlco), pulmonary capillary volume (Vc), and membrane resistance (Dm), and maximal cardiopulmonary exercise testing. In 20 patients and controls, the following investigations were also done: (1) resting and constant work rate Tlco; (2) maximal cardiopulmonary exercise testing with inspiratory O2 fractions of 0.21 and 0.16; and (3) rest and peak exercise blood gases. The other subjects underwent Tlco, Dm, and Vc measurements during constant work rate exercise. Results: In normoxia, exercise induced reductions of haemoglobin O2 saturation never occurred. With hypoxia, peak exercise uptake (peak V̇o2) decreased from (mean (SD)) 1285 (395) to 1081 (396) ml/min (p < 0.01) in patients, and from 1861 (563) to 1771 (457) ml/min (p < 0.05) in controls. Resting Tlco correlated with peak V̇o2 in heart failure (normoxia < hypoxia). In heart failure patients and normal subjects, Tlco and peak V̇o2 correlated with O2 arterial content at rest and during peak exercise in both normoxia and hypoxia. Tlco, Vc, and Dm increased during exercise. The increase in Tlco was greater in patients who had a smaller reduction of exercise capacity with hypoxia. Alveolar–arterial O2 gradient at peak correlated with exercise capacity in heart failure during normoxia and, to a greater extent, during hypoxia. Conclusions: Lung diffusion impairment is related to exercise capacity in heart failure.

[1]  J. E. Hansen,et al.  Predicted values for clinical exercise testing. , 2015, The American review of respiratory disease.

[2]  R. Zeballos,et al.  Clinical exercise testing. , 2001, Clinics in chest medicine.

[3]  M. Guazzi,et al.  Effects of simulated altitude-induced hypoxia on exercise capacity in patients with chronic heart failure. , 2000, The American journal of medicine.

[4]  M. Guazzi.  Alveolar-capillary membrane dysfunction in chronic heart failure: pathophysiology and therapeutic implications. , 2000, Clinical science.

[5]  S. Raj,et al.  Ventilatory assistance improves exercise endurance in stable congestive heart failure. , 1999, American journal of respiratory and critical care medicine.

[6]  J. Cleland,et al.  Impaired pulmonary diffusion during exercise in patients with chronic heart failure. , 1999, Circulation.

[7]  P. Agostoni,et al.  Angiotensin‐converting enzyme inhibition facilitates alveolar‐capillary gas transfer and improves ventilation‐perfusion coupling in patients with left ventricular dysfunction , 1999, Clinical pharmacology and therapeutics.

[8]  D S Sharif,et al.  Effects of low altitude on exercise performance in patients with congestive heart failure after healing of acute myocardial infarction. , 1999, The American journal of cardiology.

[9]  K. Wasserman,et al.  Exercise-induced hemoconcentration in heart failure due to dilated cardiomyopathy. , 1999, The American journal of cardiology.

[10]  F. Péronnet,et al.  Lung function and exercise gas exchange in chronic heart failure. , 1998, Circulation.

[11]  K. Wasserman,et al.  Oxygen transport to muscle during exercise in chronic congestive heart failure secondary to idiopathic dilated cardiomyopathy. , 1997, The American journal of cardiology.

[12]  P. Agostoni,et al.  Improvement of alveolar-capillary membrane diffusing capacity with enalapril in chronic heart failure and counteracting effect of aspirin. , 1997, Circulation.

[13]  J. Hosson,et al.  Influence of spring stiffness and anisotropy on stick‐slip atomic force microscopy imaging , 1996 .

[14]  M. Guazzi,et al.  Contribution of PO2, P50, and Hb to changes in arteriovenous O2 content during exercise in heart failure. , 1996, Journal of applied physiology.

[15]  J. Cleland,et al.  Reduced alveolar-capillary membrane diffusing capacity in chronic heart failure. Its pathophysiological relevance and relationship to exercise performance. , 1995, Circulation.

[16]  Y. C. Huang,et al.  Normal values for single exhalation diffusing capacity and pulmonary capillary blood flow in sitting, supine positions, and during mild exercise. , 1994, Chest.

[17]  A. Miller,et al.  Lung function testing: selection of reference values and interpretative strategies. , 1992, The American review of respiratory disease.

[18]  C. Oakley,et al.  Effects of increased inspired oxygen concentrations on exercise performance in chronic heart failure , 1992, The Lancet.

[19]  D. Bergel.  Geigy Scientific Tables , 1991 .

[20]  K. Wasserman,et al.  Evidence that diffusion limitation determines oxygen uptake kinetics during exercise in humans. , 1990, The Journal of clinical investigation.

[21]  P. Batra,et al.  Ventilatory and diffusion abnormalities in potential heart transplant recipients. , 1990, Chest.

[22]  J. Hosenpud,et al.  Abnormal pulmonary function specifically related to congestive heart failure: comparison of patients before and after cardiac transplantation. , 1990, The American journal of medicine.

[23]  D. Rosenthal,et al.  Clinical exercise testing, 3rd ed , 1988 .

[24]  J. E. Hansen,et al.  Diffusing capacity for carbon monoxide as a predictor of gas exchange during exercise. , 1987, The New England journal of medicine.

[25]  A. Miller,et al.  Standardized lung function testing. , 1984, Bulletin europeen de physiopathologie respiratoire.

[26]  F. Roughton,et al.  Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries. , 1957, Journal of applied physiology.

[27]  James E. Hansen,et al.  Oxygen uptake as related to work rate increment during cycle ergometer exercise , 2004, European Journal of Applied Physiology and Occupational Physiology.